CATARRH OF THE BLADDER CYSTITIS CATARRHALIS. 67 



muscular connective tispue, and the muscular fibres themselves, are 

 also thickened and hypertrophied. Upon the inner surface of the blad- 

 der there lies a gray puriform mucus, or a yellowish purulent secre- 

 tion. The urine contained in the bladder is often decomposed, is of 

 an acrid ammoniacal odor, and alkaline reaction. 



Chronic catarrhal cystitis rarely terminates in recovery. Far more 

 frequently, as the malady advances, the proliferation of cells upon the 

 free surface of the bladder is complicated with a vast cell-growth in 

 the tissues of its mucous, submucous, and muscular coats. In this 

 way catarrhal mucous ulcers and submucous abscesses are formed. 

 Perforation of the vesical wall sometimes takes place. Should this 

 occur after the bladder and its neighboring organs have become con- 

 solidated by pericystitis, abscesses may form around the former, which, 

 under favorable circumstances, may open either externally, or into the 

 rectum, or vagina, and, in unfavorable ones, may break into the ab- 

 dominal cavity. Another, but not a very common, result of vesical 

 catarrh is diffuse suppuration. This generally occurs in cases of reten- 

 tion of urine, and arises from the corrosive action of the putrid contents 

 of the bladder upon its mucous membrane. The mucous membrane is 

 then found to be extremely soft, discolored, and of a brownish-red or 

 blackish hue. It is covered with dirty exudation, or broken down into 

 a ragged, pultaceous substance, infiltrated with fetid pus. The mus- 

 cular fasciculi are pale and tear easily. The submucous and intermus- 

 cul&r tissue is infiltrated with ichorous matter; within the bladder 

 there is a blackish-brown, chocolate-like liquid, of an intensely ammo- 

 niacal odor, consisting of decomposed urine, blood, pus, and shreds of 

 detached mucous membrane. In the worst cases the destruction at- 

 tacks all the coats of the viscus, whose contents escape into the ab- 

 dominal cavity. 



An enormous thickening of the walls of the bladder, a common 

 result of the hypertrophy of the muscular fasciculi already referred to, 

 may be mentioned as a third termination of chronic vesical catarrh. 

 This condition, however, sometimes arises in cases of long-standing 

 impediment to the passage of the urine, without vesical catarrh. In 

 such cases the wall of the bladder attains a thickness of from several 

 lines to half an inch or more. The muscular fasciculi have .grown into 

 rounded bars, and form rib-like projections upon the interior, the ap- 

 pearance of which has been compared with that of the right ventricle 

 of the heart (vessie d colonne). According as the capacity of the 

 bladder is increased or diminished by this hypertrophy, it is called ex- 

 centric or concentric. In the former case the bladder may rise into 

 the abdomen as far up as the navel ; in the latter it may be shrunken 

 to the size of a walnut. In some cases of chronic vesical catarrh, es- 



